Protruding shoulder blade (winging scapula)

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Last updated 28/03/2022 by The pain clinics - Interdisciplinary Health

Protruding Winging Scapula

Are you bothered by protruding shoulder blades? Protruding shoulder blades, also known by their English winging scapula, mean that the shoulder blades are pulled out abnormally much.

Protruding shoulder blades are usually due to muscular imbalance. Musculus serratus anterior, which we will look at in detail later, is often considered the key to improving protruding shoulder blades. It is also often seen that winging scapula occurs simultaneously with upper crest syndrome. This involves dysfunction of the postural muscles in the upper back and chest. The muscles that most often become too active are the upper trapezius, pectoralis minor and major, levator scapulae and sternocleidomastoideus.


Article: Winging Scapula

Last updated: 28.03.2022


What is Upper Cross Syndrome?

If we get overactivity in certain muscles, and underactivity in their counterparts, this could result in attitude changes. Upper cross syndrome can include these attitude changes:

  • Forward-leaning head position
  • Forward-curved neck
  • Rounded shoulders
  • Increased curvature of the thoracic spine (humpback)

The upper croup is thus defined as a type of muscular posture condition. With the right mapping and examination by a usually modern chiropractor or physiotherapist, it will be possible to identify which muscles are involved in the problem. Then the malfunction can be addressed with the help of physical therapy and specific rehabilitation training. Later in the article, you will become better acquainted with what a holistic approach to both upper cross syndrome, and protruding shoulder blades, can look like.


- At our interdisciplinary departments at Vondtklinikkene in Oslo (Lambert seats) and Viken (Eidsvoll Sound og Raw wood), our clinicians have a uniquely high professional competence in assessment, treatment and rehabilitation training for ailments in the shoulders and shoulder blades. Click on the links or here to read more about our departments.


In this article you will be able to learn more about:

  • 1. What is the Winging Scapula?
  • Causes of Winging Scapula
  • Examination and Treatment of Protruding Shoulder Blades
  • 4. Self-action against Winging Scapula
  • 5. Exercises and Training Against Protruding Shoulder Blades (Video Included)
  • 6. Get Help: Our Clinics


1. What is Winging Scapula?

Protruding shoulder blades are thus a diagnosis in which functional causes lead to the shoulder blades being pulled too far outwards. More specifically, this is also known as lateral deviated scapular mispositioning. The condition can be both painful or virtually asymptomatic (1). However, many people may experience muscle fatigue and pain within the shoulder blades.


- Can Affect Shoulders and Neck

However, malfunction in the shoulder blades can go beyond the shoulder function, as well as the neck. Over time, it can affect a person's ability to lift, push or pull heavier things. Even everyday things, such as brushing your teeth, combing your hair or lifting your arms over your head, can be difficult to do. By changing the basic position of both shoulder blades and shoulders, we will be able to have a negative impact scapulohumeral rhythm - that is, how the shoulder blades and arms move together under load.


If such a disturbance occurs, this could lead to loss of strength, reduced mobility in the upper extremities (arms and shoulders), and be a source of pain. The pain will then often be most evident in the neck, between the shoulder blades and further out into the shoulders. Not surprisingly, it can also cause an increase in cervicogenic headaches (neck headaches).


Try it yourself: Curve the upper back and lean the neck forward. Then follow up by rounding off the shoulders. Then you can try to lift your arms and see how far you get. A good example of how impaired functionality is.


Causes of Winging Scapula

When we talk about protruding shoulder blades, we mainly think that the shoulder blades are too far out (lateral winging scapula), but the fact is that it can also occur the other way (medial winging scapula). For many who are affected by this, it can also affect them mentally, as it can affect their self-image. The cause lies mainly in reduced function and impaired strength in the musculus serratus anterior, middle and lower trapezius, as well as the musculus rhomboideus. Due to the fact that weakened muscles, naturally enough, are used less, it can also become increasingly weaker over time.


Possible Causes:

  • Muscle injuries
  • Muscular Imbalance
  • Nerve Clamping and Nerve Injury
  • Trauma and Injuries (Including sports injuries)


Two Classifications of Winging Scapula

  • Lateral winging scapula
  • Medial winging scapula

Here we first want to clarify that it is significant weakness or loss of strength in the serratus anterior that gives the medial winging scapula - that is, that the shoulder blade becomes more prominent and inverted. In contrast, there is obvious weakness in the middle and lower trapezius, as well as the rhomboideus, which produces the lateral winging scapula (uncoated). There are thus two different types - of which medial winging is the most common. Nevertheless, the conservative approach, with certain specific changes, is quite similar.


- The 3 Most Important Muscles by Devierte Shoulder Blade

  1. Serratus Anterior Muscle
  2. Middle and Lower Trapezius
  3. Rhomboideus muscle

Let's take a closer look at the main function of the above muscles. Everyone is central in movement and functionality in both shoulder blades and shoulders. In order to have better function and shoulder blade position, it is therefore essential that we work specifically with these. Many people are probably interested in hearing more about the two different forms of winging scapula.


1. Muscle Serratus Anterior

The function of the serratus anterior is to stabilize the shoulder blade, as well as help in pulling it forward (protraction) and in rotational motion. It is also responsible for holding the shoulder blade next to the rib cage. The muscle attaches to the upper 8 ribs, as well as towards the rib attachment on the inside of the shoulder blades.


The muscle serratus anterior receives its nerve signals from the levels of the thoracic nerve longus - part of the brachial plexus. Specifically from the C5, C6 and C7 nerve roots, and especially the latter. By squeezing, as by larger neck prolapse in C6-7, this nerve can be so affected that it goes beyond the muscle power to the serratus anterior. A consequence can thus be protruding shoulder blades on the side where the prolapse is located.


- The nerve can be damaged by surgery or trauma

The nerve of the serratus anterior may also, due to its position, be particularly vulnerable in certain types of surgery - and especially when removing lymph in the armpits (eg in connection with breast cancer surgery). By mistake, damage to this nerve can occur during operations in this area. The nerve can also be damaged by injuries and trauma - such as sports injuries.


- The majority of protruding shoulder blades are due to the serratus anterior

Protruding medial-deviated shoulder blades are the most common presentation of the winging scapula. The condition can range from mild, to moderate and in some cases significant. Conservative physical therapy in combination with rehabilitation training will be able to restore significant function in the majority of cases.


2. Middle and Lower Trapezius

The trapezius muscle consists of 3 parts - upper, middle and lower. Overall, these are very important muscles for good function and posture. With winging scapula, we are particularly interested in the middle and lower part, so let's take a closer look at these.


- Upper Trapz: Starts at the base of the neck and extends towards the upper layer of the shoulders on both sides.

- Middle Trapezius: This part of the muscles is located just below the upper trapezius, and runs all the way to the back of the shoulders. This is incredibly important for protruding shoulder blades because it helps you pull your shoulders back and bring your arms back. In addition, it stabilizes your shoulders as you move your arms.

- Lower Trapezius: The lower part of the trapezius is also the largest. It goes in a v-shape from the inside, and partly over, the shoulder blades down to the lower thoracic spine. The main function involves pulling the shoulders down from the ears and stabilizing the thoracic spine with certain movements - including bending and twisting.


- Malfunction of the middle and lower trapezius can contribute to shoulder blade problems

When we see the function of the middle and lower trapz, we understand how obvious weakness and loss of strength can cause a changed shoulder blade position. These are muscles that are strongly involved in pulling the shoulder blades down and back. Thus, it is natural that a lack of strength in these - together with the rhomboideus - could result in protruding shoulder blades.


3. Rhomboideus

Musculus rhomboideus consists of minor and major. The muscle attaches to the thoracic spine, the neck transition, and to the inside of the shoulder blade. This mainly receives its nerve signals from the C5 nerve root, so a strong pinching or damage to this nerve root could result in impaired function and loss of strength in the rhomboideus. An example might be a larger one neck prolapse in C4-C5. The main function of the muscle is to pull the shoulder blade inwards, as well as contribute to the rotation of the shoulder blade.


Examination and Treatment of Winging Scapula

  • Functional and Clinical Examination
  • Imaging Diagnostic Examination (if medically indicated)
  • Physical Treatment of Malfunction and Pain
  • Specific Rehabilitation Training


Examination of Protruding Shoulder Blade

A first-time consultation always starts with a history-taking. The clinician will then perform a clinical and functional examination. This may include testing of muscles, range of motion, nerve tension and specific orthopedic tests. Overall, this will give the therapist information about which muscles and restrictions are involved in the problem. Our clinicians at Vondtklinikkene also have the right to refer for an diagnostic imaging examination if this becomes necessary.


Physical Treatment of Protruding Shoulder Blades

Improper positioning of the shoulder blades can provide a basis for both muscle knots, stiffness and joint restrictions. Many people with protruding shoulder blades also suffer from pain between the shoulder blades and in the neck transition. Physical therapy techniques, performed by a modern chiropractor or physiotherapist, in the form of muscle therapy, intramuscular acupuncture, laser therapy and joint mobilization can provide symptom relief and functional improvement. This is performed in combination with specific rehabilitation exercises.


Specific Rehabilitation Training

The functional examination and clinical findings will facilitate how to set up the rehabilitation training. These will primarily be training exercises that target the identified muscle weaknesses and malfunction (3). However, there are home exercises you can successfully start with today - and we will show you them in the video further down in the article. But for the best possible results with progression follow-up, we ask you to contact professional help. Remember that our clinicians at Vondtklinikkene are happy to help you.


4. Self-measures against Protruding Shoulder Blade

The most important self-measure you can start with today is to train the rotator cuff muscles (shoulder stability muscles) with elastic. Secondly, measures such as acupressure mat and trigger point balls can help reduce muscle tension in the back and help you pull the shoulder blades backwards.


Tip 1: Training with Elastic Elastic

This is the type of elastic we use in rehabilitation training against protruding shoulder blades. Strength training with elastic is considered one of the very best ways to strengthen the shoulder blades and shoulders. The advantage of this elastic is that it is wider and easier to handle. Click on the image or link above to read more about it - and see purchase options (the link opens in a new window).

Tip 2: acupressure mat og Trigger point ball

Unfortunately, many people with protruding shoulder blades and rounded shoulders suffer from muscle pain. An acupressure mat has massage points that can work towards tense muscles in between the shoulder blades and the back. This model also has a separate neck part that makes it easy to work with tense neck muscles. Press here to read more about it.


5. Exercises and Training Against Protruding Shoulder Blades (+ Video)

We promised you a video that shows good strength exercises for your shoulders and shoulder blades. In the video you will be able to see that we use training elastic of the type we linked to above. The exercise program can be done every other day - and you should notice a clear effect within 16-20 weeks. Continuity is the key to good training results, so get yourself a good routine of doing them regularly.


Schedule 1: Try to do this 3 times a week for 16 to 20 weeks. In the video, chiropractor Alexander Andorff shows by Lambertseter Chiropractor Center and Physiotherapy in Oslo show how to do the exercises.


VIDEO: Strength Exercises for Shoulder Blade and Shoulders

Join our family! Subscribe for free on our Youtube channel (click here - the link opens in a new reader window) for more good exercise programs and replenish with health knowledge.


6. Get Help and Answers: Our Clinics

We offer modern assessment, treatment and training for shoulder blade ailments - including winging scapula.

Feel free to contact us via one of our specialized clinics (the clinic overview opens in a new window) or on vår Facebook-side (Vondtklinikkene - Health and Exercise) if you have any questions. For appointments, we have XNUMX-hour online booking at the various clinics so that you can find the consultation time that suits you best. You can also call us within the clinic's opening hours. We have interdisciplinary departments in Oslo (included Lambert seats) and Viken (Raw wood og Eidsvoll Sound). Our skilled therapists look forward to hearing from you.


«- Remember that one of the most difficult things is to actually take the first step over the doorstep. Take charge of your own health today. We are happy to help you all the way to the goal. "


With the best wishes for good health on,

The pain clinics - Interdisciplinary Health


Research and Sources:

1. Martin et al, 2008. Scapular winging: anatomical review, diagnosis, and treatments. Curr Rev Musculoskeletal Med. 2008 Mar; 1 (1): 1–11.

2. Gray's Anatomy of the Human Body [Public Domain]

3. Saito et al, 2018. Scapular focused interventions to improve shoulder pain and function in adults with subacromial pain: A systematic review and meta-analysis. Physiotherapist Theory Pract. 2018 Sep; 34 (9): 653-670. [Meta-analysis]

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